290 NE 98 St (12)i
Date �? Job Address 90 Q' /c' J T Tax Folio // .7 B oc. ®/i ,yam
e-. 4LLLs
Legal Description /4 5 Sic / od sei� P /6 7 0 Historically Designated: Yes No •
Owner/Lessee / Tenant /i.4 / Jar a 2," s Pee s 5, 7-e :ft 4AJ 0 � Mast Permit # q 6s
Owner's Address (0 6 2 4/ @' 94, Sr Phone 75 = 9'.3
Contracting Co. C5 w N a 2 Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor
Permit Type (circa¢ one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
r-E,e; o &24- -4_ s i�c ° s�_ L54/11
WORK DESCRIPTION
Square Ft.
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOU PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER O '!' AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
FEES: PERMIT ga RADON
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
ure of o - and/or Condo President
Notary as to Owner and/or Condo President Date
My Commission Expires:
Address
Estimated Cost (value) 6
OWNER'S AFFIDAV certify that all the foregoing informati
laws regulatin.g_co �� . ; d zoning. Furthermore, I autho • -- the above -named con
Notary as to Contractor or Owner�Builder
My C1 m ow p e stc;t n �, C W: 1, r ' ,I. -11 i
I `(V -QC" ( n ^?1;7;%'•fr", I�
�qe7 C"1 cr < ..,_
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MF.C. ' AL WORK.
s accurate and that all
one in compliance with all applicable
st ted.
Signature of Contractor or Owner- Builder Date
Date
C.C.F. 6 cv NOTARY. S TOTAL DUE (T
APPROVED:
Zoning Building `� 1 zt, Electrical
Mechanical Plumbing Engineering